The Clinical Research Of Stroke Volume Monitored By Flotrac/Vigileo With Or By Transesophageal Echocardiography To Guide Capacity Infusion During Robot Laparoscopic Colorectal Cancer Surgery

Objective:The clinical research of comparing stroke volume monitored by FloTrac /Vigileo with stroke volume by intraoperative ultrasound of the esophagus to guide capacity infusion used in robot assisted laparoscopic colorectal cancer surgery.Methods:Selecting 30 patients with elective robot assisted laparoscopic colorectal cancer,internal jugular vein puncture catheter under local anesthesia and arterial puncture with 22 G catheter and connecting FloTrac/Vigileo equipment monitoring stroke volume(SV).To give 1.5mg/kg Propofol,0.15 mg/kg Cisatracurium Besilate,Dexmedetomidine 0.5?g/kg,0.3?g/kg sufentanil 0.3?g/kg anesthesia induced,after the success of the endotracheal tube inserted into ultrasonic probe of the esophagus to monitor the SV;Record surgery patients with preoperative age,weight,heart rate,red blood cells deposited,left ventricular ejection fraction,basic diseases(diabetes,hypertension and congestive heart failure,etc.);Record 4 min after endotracheal intubation(T1),4 min after the start of pneumoperitoneum combined with30°head-down position(T2)and 4 min after through central venous quickly infusion6% hydroxyethyl starch 250 ml on T2(T3)in patients with mean arterial pressure(MABP)and heart rate(HR),SV value obtained by FloTrac / Vigileo system and esophageal ultrasonic respectively,then through the Pearson correlation analysis and Bland-Altman plot to evaluate the consistency of the both.Results:1.Compared with T1,value of MABP,the SV of FloTrac / Vigileo(SV-Vigileo)in T2 was higher,but value of HR was lower,and the difference has statistically significant(P < 0.05);Compared with T1,value of MABP and HR,the SV measured by esophagus ultrasonic(SV-TEE)and SV – Vigileo in T3 were significantlyincreased(P < 0.05);Compared with T2,value of SV-TEE and SV-Vigileo in T3 were higher(P < 0.05);2.Compared to the same moment of T2,T3,value of SV-TEE were lower than those value of SV-Vigileo in the same moment(P < 0.05);The MedCalc software for Pearson correlation analysis,it is concluded that the correlation coefficient r of value of SV-TEE and SV-Vigileo in T1 was 0.85,P < 0.0001),however the Pearson correlation analysis of those in T2 and T3 were poor difference(P > 0.05);3.Bland-Altman analysis in T1 showed that the consistency of the two kinds of measurements were good;But patients after pneumoperitoneum combined with30°head-down position(T2,T3),Bland-Altman analysis showed that the consistency of the two measurements was poor and difference of the measured results were roughly 22% to 42%.Conclusion:SV monitored by FloTrac / Vigileo in the pneumoperitoneum combined with30°head-down position during laparoscopic surgery and fluid therapy in that case may overestimate its value,However,TEE can look straight into the heart activities and has better prediction or assessment in monitoring of hemodynamics.